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Patients with diabetes are less likely to have a heart attack or die if they stay on anti-clotting medication for a full year after a stenting procedure.
A stent is a very small metal mesh cylinder that's inserted into a cardiac artery after it's become choked off by atherosclerosis. The stent acts like a scaffold to prop open the artery, allowing a healthy volume of blood flow. To prevent tissue from growing over the stent and re-blocking the blood vessel, stents are often coated with slow-release drugs that keep the growth from occurring; these are called drug-eluting (drug washing-out) stents. Stents that are not coated with drugs are called bare metal stents.
Patients who've had a stent inserted must take an anti-clotting agent such as aspirin and clopidogrel (Plavix). In general, the medication is prescribed for six or more months after the stenting, to prevent the blood from reacting to the stent by thickening and clogging up the newly expanded artery (thrombosis). The hope is that a smooth, thin layer of endothelial cells (the inner lining of the blood vessel) grows over the stent during this period and incorporates it into the artery, reducing the tendency for clotting.
Now research has shown that a full year of treatment with the anti-clotting agent clopidogrel, twice as long as the standard six-month treatment, offers significant benefit to people with diabetes. In the study, 671 diabetic patients who had a stenting procedure were followed. A year after the procedure, patients were less likely to have suffered a heart attack or died if they had continued to take clopidogrel for the full year. Even with bare metal stents, long-term clopidogrel significantly reduced the risk of death or heart attack.
The researchers speculated that year-long clopidogrel therapy is helpful because it prevents blood clots from forming on inflamed plaques throughout the diseased coronary arteries, not just on the stent itself. Continuing the therapy longer than a year did not further reduce risk.
Source: Society for Cardiovascular Angiography and Intervention
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